California Family Physician (Summer 2013) by California Academy of Family Physicians

California

FAMILY PHYSICIAN Vol. 64 No.3 Summer 2013

MEETING THE LEADERSHIP CHALLENGE COuLD CHANGE HOw HEALTHCARE AND PRIMARY CAre Are exPerIeNCed 17 INTRODuCING JACk CHOu, MD … LEADING FROM THE HEART

CAFP LEADERS OFFER GuIDANCE AND INSPIrAtIoN

CAFP PROuDLY HONORS SIx FAMILY MedICINe LeAderS

Jack Chou, MD, Candidate for the AAFP Board of Directors Jack Chou in washington DC, and with his family Sarah, Samantha, wife kathy, and Nathan.

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1520 Pacific Avenue • San Francisco, California 94109 • www.familydocs.org Phone (415) 345-8667 • Fax (415) 345-8668 • E-mail: cafp@familydocs.org

Officers and Board

Staff

President Mark Dressner, MD

Allison Bauer

President-Elect Delbert Morris, MD

abauer@familydocs.org

Immediate Past President Steven Green, MD

Manager, Medical Practice Affairs

Speaker Jay Lee, MD, MPH Vice-Speaker Lee Ralph, MD

Manager, Communications and Website

Jane Cho

jdavis@familydocs.org

Adam Francis

ckear@familydocs.org

Deputy Director, Government Affairs

afrancis@familydocs.org

shenry@familydocs.org

CMA Delegation Ashby Wolfe, MD, MPP, MPH Nathan Hitzeman, MD Michelle Quiogue, MD Suman Reddy, MD Kevin Rossi, MD Patricia Samuleson, MD

Jerri Davis, CCMEP

Cynthia Kear, MDiv, CCMEP

Executive Vice President Susan Hogeland, CAE

AAFP Alternates Jeffrey Luther, MD Eric Ramos, MD

shogeland@familydocs.org

jcho@familydocs.org

Sophia Henry

AAFP Delegates Jack Chou, MD Carla Kakutani, MD

Cody Mitcheltree

Executive Vice President

Senior Manager, CME/CPD

Secretary/Treasurer Lisa Ward, MD

Foundation President Michael Rodriguez, MD, MPH

Susan Hogeland, CAE

Associate Director, Membership and Marketing

California FAMILY PHYSICIAN Quarterly publication of the California Academy of Family Physicians

• Julia Blank, MD • Nathan Hitzeman, MD

Senior Vice President

Callie Langton, PhD

CAFP-F Executive Director, Director, Health Care Workforce

clangton@familydocs.org

Student, Resident and Social Media Manager

cmitcheltree@familydocs.org Leah Newkirk Vice President, Health Policy lnewkirk@familydocs.org Shelly Rodrigues, CAE, FACEHP Deputy Executive Vice President

srodrigues@familydocs.org Kelly Goodpaster

Manager, Financial Services

kgoodpaster@familydocs.org

Michelle Quiogue, MD, Editor Shelly Rodrigues, CAE, Managing Editor Communications Committee: Michelle Quiogue, MD, Chair • Jeffrey Luther, MD • Jay Mongiardo, MD

The California Family Physician (CFP) is published quarterly by the California Academy of Family Physicians (CAFP). Opinions are those of the authors and not necessarily those of the members and staff of the CAFP. Non-member subscriptions are $35 per year. Call 415-345-8667 to subscribe.

• Albert Ray, MD

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4 California Family Physician Summer 2013

P u b l i c H e a lt H a n d Y o u 16 Reflections from the National Congress of Special Constituencies

Sophia Henry and Marie-Elizabeth Ramas, MD

17 Meeting the Leadership Challenge Could Change How Healthcare and Primary Care are Experienced

Edward O’Neil, PhD

18 Introducing Jack Chou, MD … Leading from the Heart 20 Jack Chou, MD … At A Glance 23 CAFP Leaders Offer Guidance and Inspiration

26 CAFP Proudly Honors Six Family Medicine Leaders

Taejoon Ahn, MD, MPH Ann Lindsay, MD Jay Lee, MD, MPH Ron Chapman, MD, MPH Alan Glaseroff, MD Michelle Quiogue, MD Thomas C. Bent, MD Raul Ayala, MD Alex “Sandy” Sherriffs, MD Joan Rubinstein, MD Catherine Sonquist Forest, MD, MPH

Editorial

Family Physicians Are the Long Awaited Heroes

Michelle Quiogue, MD

President’s Message

Leadership, Baseball and Taking Stock of Our Leaders

In the News

Congrats! Two California Medical Schools Receive AMA Grants CAFP Now Offering PCMH Coaching Services! Spotlight on Noridian: California’s New Medicare Administrative Contractor (MAC)

Mark Dressner, MD

11 PCMH Corner

Physician Champion Grant Nakamura, MD is Leading a PCMH Revolution

14 Political Pulse

The Challenges in Sacramento Just Keep on Coming … But CAFP Is in for the Full Fight

15 Foundation News

Ashby Wolfe, MD, MPP, MPH

California Has a Banner Match Year … A Fourth Straight Banner Match Year

30 Executive Vice Presidents Forum

Leah Newkirk

Callie Langton, PhD

Family Physicians Can Help Patients Understand ACA

Susan Hogeland, CAE

For the upcoming CME calendar go to www.familydocs.org California Family Physician Summer 2013 5

Michelle Quiogue, MD

editorial

Family Physicians Are the Long Awaited Heroes

“Teamwork is the ability to work together toward a common vision. The ability to direct individual accomplishments toward organizational objectives is the fuel that allows common people to attain uncommon results.” – Andrew Carnegie

In this issue, California Family Physician celebrates the individual accomplishments of family physicians in service to patients, to communities and to organized medicine. CAFP past president Jack

Chou, who has graced these pages many times and does so again, continues to rise to the call of duty. This year he seeks to represent us on the AAFP Board of Directors. We highlight the vast and varied experiences that have prepared Dr. Chou to tackle this new challenge. Elections will take place at the AAFP Congress of Delegates in San Diego this fall, and your Academy will be there to support his candidacy every step of the way.

6 California Family Physician Summer 2013

While family physicians work daily to improve the health of our patients, the California Health Care Foundation’s (CHCF) mission is to work as a catalyst to fulfill the promise of better health care for all Californians. Several CAFP members have participated as fellows in the CHCF Leadership Program and will spearhead innovations that improve quality, increase efficiency and lower the costs of health care. We take a closer look in this issue at the work each of them champions. As more family physicians step up to fill policy and administrative positions, those of us on the front lines can feel more confident that our issues and experiences will lead decision-making in the future. While that future may seem at once on the verge of overtaking the present and just beyond our reach, still each of us rises daily to the call of duty, to do our part to heal our patients and our communities. The current and changing health care system relies on family physicians more now than ever before. Perhaps, in some ways, family physicians have become the long-awaited heroes to come out from the shadows to save our broken system. Without a doubt, we can think of recent stories of heroism in our offices. Sometimes, it can feel like a heroic effort to get patients with Medi-Cal appropriate and timely care. Sometimes, it can feel heroic to negotiate positive behavior and lifestyle changes with patients. Sometimes, it is our own health challenges that bring our heroism to the surface. And so, this issue also celebrates each of our members and the leadership each of you provides on the front lines. With so many CAFP members fueling the revolution, there can be no doubt that the future will be indelibly marked by these efforts.

President’s message

Mark Dressner, MD

Leadership, Baseball and Taking Stock of Our Leaders Bases loaded. Play at any base. Easy out!

encouraging input and involvement from as many members as possible. Three simple phrases and my son had set the tone for the team – the situation had been described, directions had been given and the ending was encouragement. Believe me, it was wonderful to see the coaches sit back a minute and let the team move forward with their temporary new leader.

During every sport this last year (soccer, basketball, and baseball), each of my son’s coaches told me that they were looking for leadership from Trevor out on the field or on the court. Although that sounded good, I was not really

sure what they were looking for or, even more, how to encourage and teach leadership to a 9-year-old. Then one game I heard my son yell the quote above. It became clear that he was doing it. What does this show? “Bases loaded.” First of all, a leader has to listen. He or she must know when to stop talking and pay attention. What are people saying? What is going on around them? One needs to be able to see the objective aspects of any given situation. A leader then needs to succinctly summarize the situation. A leader needs to tell people what to think about but not necessarily how to think about it, as I learned at a recent seminar. “Play at any base.” A leader has to set direction. Where do we want to go and how are we going to get there? Is there more than one way to achieve the goal? Are all ways to the goal equal? What are the pluses and minuses of the alternatives? “Easy out!” A leader has to inspire. He or she needs to bring out the best in people. Strengths must be identified. The use of these strengths should be encouraged. A leader must try to involve everyone,

California is so fortunate to have one of our physician leaders on the national stage. Dr. Jack Chou, former CAFP president, is running for the board of the American Academy of Family Physicians. Jack has an amazing resume of involvement in organized medicine beginning in his first year in medical school. He has held leadership positions in CAFP, AAFP, the Los Angeles County Medical Association, the California Medical Association and the American Medical Student Association. He also has had an impressive list of leadership positions within Kaiser-Permanente. I have known Jack for more than a decade. He impressed me from the moment I met him. He has a gentle, kind demeanor. He speaks softly but authoritatively. He is so involved in his professional organizations that he has acquired a huge knowledge base on so many of the issues in 2013 medicine. He never rushes to speak. He listens. He takes his time. He then joins in. He is one of those people who, when he speaks, I listen. He can describe the issue well and discuss the different ramifications of the choices we have to make. I find him persuasive and inspiring. Like the blossoming of leadership that my son exhibited on the baseball field, Jack Chou fulfills the same role masterfully within our professional organization and the house of medicine in general. Please sit back and think about the characteristics you deem are important in a leader as you read through this issue. What are your expectations of the leaders of your state and national organizations? Please, I would love to hear from you about any issues. Let’s start a dialogue! You can email me at mdressner@familydocs.org. I would like to close with this message. To all of you who know me well, stop laughing over my starting this article with a baseball quote. Although I have been scorekeeper for Trevor’s baseball teams the last two years, it wasn’t until this third year that I finally realized that there are not two shortstops. (So that’s where the second baseman keeps disappearing to!) Sometimes a leader just has to admit when he doesn’t know something.

California Family Physician Summer 2013 7

in tHe neWs Congrats! Two California Medical Schools Receive AMA Grants

Congrats! Two California Medical Schools Receive AMA Grants University of California, Davis and University of California, San Francisco are two of 11 medical schools that will receive grant in the American Medical Association’s Accelerating Change in Medical Education initiative. The initiative is aimed at transforming the way future physicians are trained. “We are thrilled to award funding to 11 medical schools for their bold, transformative proposals designed to close the gaps between how medical students are trained and how health care is delivered,” said AMA President Jeremy A. Lazarus, MD “This AMA initiative will identify specific changes in medical education that can be applied in medical schools throughout the nation to enable students to thrive in a changing health care environment and improve the health of our nation’s patients.” The AMA will provide $1 million to each school over five years to fund the educational innovations envisioned by each institution. A critical component of the AMA’s initiative will be to establish a learning consortium with the selected schools to rapidly disseminate best practices to other medical and health profession schools. For more information about the initiative, visit www.changemeded.org.

CAFP Now Offering PCMH Coaching Services!

The growing emphasis on the Patient Centered Medical Home (PCMH) model has resulted in exponential growth in the field of practice transformation in recent years. California family physicians are driven to transform to the PCMH model, but need in-practice support to make the change. CAFP is now offering practice transformation coaching

8 California Family Physician Summer 2013

in tHe neWs and web-based support services to meet the needs of our member physicians in their diverse practices through two partnerships: one with transformation consulting firm HealthTeamWorks and a second with the California Primary Care Association and transformation consulting firm Arcadia. • CAFP and HealthTeamWorks offer you: • Development and management of PCMH pilots, demonstrations or initiatives. • In-office quality improvement coaching. • Residency program PCMH implementation. • Training and mentoring of internal quality improvement coaches. • Assistance with NCQA Recognition. • CAFP, the California Primary Care Association and Arcadia offer you: • The “Patient Centered Medical Home Accelerator Portal,” a web-based project management tool that facilitates the NCQA recognition process. Practices build an NCQA recognition implementation roadmap with a practice coach using baseline assessment data and use the portal to track their progress as they work through their roadmap. • In-office quality improvement coaching. • Learning modules on the PCMH model. • A data management and analytics tool designed for practice reporting needs. To provide better care for your patients and to position yourself for better pay in the future as a “high-value” provider, recognized as a PCMH, we urge you to contact us and learn more. Contact CAFP’s Jane Cho or visit http://www.familydocs.org/practice-resources/pcmh to start your transformation TODAY.

in tHe neWs Spotlight on Noridian: California’s New Medicare Administrative Contractor (MAC)

CAFP’s Manager of Medical Practice Affairs, Jane Cho, met with Noridian staff on June 18 in South San Francisco. The Centers for Medicare & Medicaid Services (CMS) announced last September that Noridian, headquartered in Fargo, North Dakota, would be the new Medicare Administrative Contractor (MAC) for Jurisdiction E (JE). Since then, CAFP has worked with Noridian, our current Medicare contractor, Palmetto GBA and the CMS to ensure a seamless and timely implementation of Noridian as the new MAC. Important Dates! All work will be transferred to Noridian on the following dates regardless of the date of service, including work in progress and work not yet started. Part A implementation and cutover date: August 26, 2013. Part B implementation and cutover date: September 16, 2013 Noridian is currently working hard to ensure minimal disruption, no lapse in payment, effective communication with providers and a continuity of policies. Important Contact Information! Website: To ensure you are receiving current information regarding JE implementation, visit Noridian’s website at www.noridianmedicare.com/JE Newsletter/Listserv: Providers do not have to register to receive newsletters from Noridian unless you registered for Palmetto’s newsletter/listserv on or after March 1, 2013. • If you are a provider who registered for the newsletter on or after March 1, go to www. noridianmedicare.com and select “E-mail Newsletter Sign Up” at the bottom of the left-hand navigation menu and follow the instructions. Email: JEQuestions@noridian.com Implementation Hotline: 1-800-361-8289 What Stays the Same and What Will Change? Some important changes may affect you during implementation. Noridian is working to minimize change to allow for a smooth transition, so electronic fund transfers will remain the same and no new paperwork must be completed. Local Coverage Determination (LCD) policies will also remain the same, which means all Part A and Part B policies from Palmetto will stay in effect. Actual policy numbers will change, but no action is required on your part. And finally, the listserv will not change. Noridian received Palmetto’s email listserv; providers who registered for Palmetto’s newsletter/listserv

prior to March 1, 2013 should have already received emails from Noridian. Please subscribe to their listserv if you have not received any notifications (see Newsletter/listserv contact information above). Noridian will have a single toll-free number for all provider inquiries. That number will be open to providers after the implementation date. A new provider portal called “Endeavor” that is similar to Palmetto’s web portal will also be available. Please go to Noridian’s website for a tutorial on “Endeavor.“ Noridian will also have a call center in Westminster to ensure a physical presence in California. What Can You Do To Make the Transition Smoother? CAFP recommends you check your National Provider Identifier (NPI) via the National Plan and Provider Enumeration System (NPPES) and ensure that all information is updated and correct. One typical cause for delay is not having your Legal Business Name (LBN) listed. If you are an individual with a type 1 NPI, be sure your name matches what is currently on file with the Social Security Number (SSN). If you are an organization with a type 2 NPI, be sure your LBN is listed as it appears with the IRS. A backlog will occur if your LBN and NPI do not match. If you are an organization and are not currently approved enrolled in PECOS, we recommend starting the certification process. This allows you to make updates directly online. PECOS Web applications have a much shorter processing time for approval. And finally, please sign up for the email listservs for current updates. Details are mentioned under the “Important Contact Information” section. Electronic Data Interchange Electronic Data Interchange Support Services (EDISS) is responsible for electronic exchange of health care transactions with providers, billing services and clearinghouses. EDISS is committed to working with Palmetto and Noridian to be transparent and ensure a seamless implementation of all electronic transactions. EDISS is allowing early boarding before Part A and Part B cutover. It is recommended that you take advantage of this option to ensure you are prepared for the JE cutover. Noridian can establish a connection between you (or your vendor) and EDISS to work out any bugs in advance. Please contact EDISS at www.edissweb.com or call 855-7214184 if you are interested in early boarding. If you have questions about Noridian or the important changes during implementation, please contact Jane Cho at jcho@familydocs.org.

California Family Physician Summer 2013 9

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PcmH corner

Leah Newkirk

Physician Champion Grant Nakamura, MD is Leading a PCMH Revolution In July 2012, the California Academy of Family Physicians, Fresno Unified School District and primary care provider group Community Medical Providers (CMP) launched a Patient Centered Medical Home (PCMH) pilot in Fresno, California to strengthen primary care, generate savings and improve quality and health outcomes. This pilot is unique in California because of the involvement and financial support of a payer. The School District, a self-insured employer, manages the health benefits for 25,000 active employees, dependents and retirees through a Wellpoint/Anthem Blue Cross Prudent Buyer PPO. The enlightened School District saw primary care and the PCMH model as a way to improve the overall health of its beneficiaries, who are disproportionately suffering from chronic illness. The School District approved a budget of about $450,000 for the first 18 months of this pilot. This budget covers a three-tier payment system – fee-for-service, a $10 perbeneficiary-per-month payment and a bonus payment for quality and cost-savings metrics achieved – for the 2,751 School District beneficiaries that are participating in the pilot. In this Leadership issue of the California Family Physician, the story that needs to be told is the story of CMP and physician champion Grant Nakamura, M.D. Transformation to the PCMH is a heavy lift for a primary care provider group and requires a commitment to the “triple aim” vision of better care, better health and lower costs. CMP is a group of 45 physicians and nurse practitioners dedicated to the good health of Central California families and to this vision. Dr. Grant Nakamura, a practicing family physician for 28 years and a graduate of the University of California, San Diego School of Medicine and the University of California, San Francisco Residency Program, is the Medical Director of CMP. He embraced the PCMH model and the resulting change that will help his group thrive in the future. CMP and Dr. Nakamura are a success story that is just beginning. In the first six months of the Fresno PCMH

pilot, the group saw improvements in almost every quality measure. Patients with diabetes and heart disease saw improvements in their care and health. The School District’s plan saw savings of more than $1.8 million dollars attributable to the pilot. CMP is honoring its patients through a commitment to continuously improving care and is readying itself for a future in which payment is increasingly tied to value. Dr. Nakamura answers our questions:

What motivated you to lead your medical group through a practice transformation? The practice of medicine had been gradually changing across the country and CMP started thinking about how to transform our current style of practice into a PCMH. We introduced the concept at our practice retreat two years ago. Any hesitancy really had to do with the additional expenses involved in the transformation. When the opportunity came along with CAFP and HealthTeamWorks, an organization that offers quality improvement coaching services, to help in the transformation along with a self-funded employer willing to fairly compensate us, it just seemed like the timing was right to begin the process.

What did your group gain from the experience? We learned that by working together, we can achieve our goals, and by embracing change, we can provide better care and access for our patients. Our various sites have really come together to help one another out. We are still in the early stages of the transformation, and in the process of changing roles, delegating responsibilities and working more closely together as a team.

What were the obstacles you had to overcome as the group’s leader? Change is always scary and challenging; its gets people out of their comfort zone. Driving consistent change in a diverse group is also a challenge. CMP has a wide variety of practice styles and personalities and each provider is at a different stage in his or her career – some are just starting while others are approaching retirement.

Can anyone take on this kind of leadership role? What traits/knowledge/skills are valuable? Yes. You need to be humble, tolerant, respectful of others’ opinions and new or different ideas and willing to listen and seek help. The mission and vision for the group must be Continued on page 12

California Family Physician Summer 2013 11

PcmH corner

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Do you agree that family physicians must increasingly take on leadership roles – in medical groups, IPAs, ACOs, etc. – to thrive in the evolving, more integrated health care world? What skills or knowledge must family physicians have to do this? Absolutely; we are the best at taking care of the patient and family as a whole, but it takes a team. We need to recognize that we cannot do it all ourselves – we need help. Care coordinators, chronic care managers, RNs, MAs, dieticians, pharmacists, great office staff, specialists and hospitalists all have a role, but it all starts with the primary care physician as the leader of the care team.

Has your leadership role in your medical group affected your practice/ your experience with patients? I have always tried to lead by example. What has become personally challenging is that with all the other changes happening in our group, it has decreased my time seeing patients. As a result, I really have to rely on my care team. CMP has been successful in our endeavors because of great leadership – and I am not talking about me. We have great Team Leaders and Provider Champions at all our sites. We had a great coach from HealthTeamWorks to help and were fortunate to find our own coach and chronic care manager to lead and continue the momentum of the transformation. CMP has been blessed by a terrific group of providers and staff, along with great support from their families. California family physicians can contact CAFP’s Vice President of Health Policy, Leah Newkirk, at cafp@familydocs.org or 415.345.8667 with any questions.

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California Family Physician Summer 2013 13 AM 5/14/13 11:41

Ashby Wolfe, MD, MPP, MPH

Political Pulse

The Challenges in Sacramento Just Keep on Coming … But CAFP Is in for the Full Fight

We’re only half way through the 2013-14 legislative session, but it has already been one of the more challenging in recent memory. Count the battles: intense discussions about health care and health policy in the state, fighting to bring extra funds into primary care residency programs, clashing with non-physician health care practitioners looking to inappropriately expand their scope of practice, battling the state in its effort to rapidly transition all public program patients into MedCal Managed Care while simultaneously cutting Medi-Cal payment.

If that were not enough, the trial lawyers have set their sights on amending or eliminating the Medical Injury Compensation Reform Act (MICRA). For more than 35 years, MICRA has ensured patient access to health care providers by limiting growth in medical malpractice premiums. The spirit behind each of these political challenges contrasts with the great enthusiasm and hope for the successful implementation of the Affordable Care Act in California. This exciting prospect is also coupled with concern, as major reforms and policy changes are being proposed to help the state cope with the large influx of newly-insured patients into the market. Throughout this time of great change, it has been inspiring to see family physicians, residents and medical students from across the state rise up and fight for family medicine and their patients. We do not use that term “fight” lightly. These ongoing battles have serious consequences. Three different health care provider groups introduced legislation that would greatly expand their scope of practice: nurse practitioners, optometrists and pharmacists. Under the reasoning that there are not enough primary care physicians in the state, the nurse practitioners have pushed for independent practice, and the optometrists seek to diagnose and treat any medical condition that manifests in

14 California Family Physician Summer 2013

the eye, including diabetes. While we, like all of you, know the value of team-based care and the important role these health care providers play on that team, our education and experience leads us to recognize such changes would negatively affect patient safety and our health care system. Family physicians throughout the state have taken action, calling their legislators and letting them know that reforms need to be focused on “team,” not “turf.” Creating positive change takes just as much effort as preventing negative outcomes. That is why family physicians and patient advocates have rallied in support of CAFP’s two sponsored bills. Assembly Bill 1208, authored by chair of the Assembly Health Committee and pediatrician Richard Pan, MD, will create a definition for “medical home” in state law. This bill recently passed the Assembly with overwhelming support and will be heard in the State Senate soon. Assembly Bill 1176, authored by Assemblymember Raul Bocanegra, would have created a Graduate Medical Education (GME) Fund to support residency programs located in medically underserved areas with a proven record of serving underserved populations and placing graduates in those areas. Unfortunately, AB 1176 was held up in the legislative process, but CAFP is considering other avenues to achieve the same goal. The greatly improved economic outlook in California will bring a lot of opportunity, but opportunities will pass us by unless we marshal our collective efforts to help our colleagues who may be less involved in advocacy to start thinking “outside of the exam room” and stand up for their patients in board rooms, political campaigns and the halls of the Capitol. It will take all of us. Please join us in this effort. To learn more about how you can be involved, please go to www.familydocs.org/advocacy. Dr. Wolfe is Chair, CAFP Legislative Affairs Committee.

Foundation neWs

Callie Langton, PhD

California Has a Banner Match Year … A Fourth Straight Banner Match Year For the fourth straight year, 2013’s National Resident Matching Program (NRMP), known colloquially as “The Match,” was a success for California’s family medicine residency programs..

High school students in the Future Faces of Family Medicine Program in Santa Rosa learn that family medicine is not just about sore throats and physicals during a suturing workshop.

California increased the number of residency positions offered in family medicine from 309 to a whopping 340. Despite the increase in positions, California filled more than 99 percent of available positions, a great sign that our state is responding to the need for more family physicians. The number of U.S. medical school seniors entering family medicine residencies in California went down slightly, but this metric may not be an indicator of interest. Programs accept the best applicants regardless of whether they attended a U.S. or international medical school. Due to restrictions in funding for medical schools and lack of growth among medical schools, talented U.S. students also sometimes leave the U.S. to attend medical school, making the distinction between “U.S.” medical graduates and “international” medical graduates less important than ever before. Despite the increase in medical school interest and slots in California, available residency slots are not keeping pace with supply. For the second time in three years, the number of U.S. medical school graduates has outpaced the number of nationally available residency training slots in the Match, leaving medical students without a place to continue their training and often owing large student loans. These issues and more will be the focus of many CAFP and CAFP Foundation efforts during the next few years. In addition to California’s stellar Match numbers, four new family medicine programs will accept their first classes in 2013, and all four programs, as well as the Kern Medical Center’s program (that CAFP and others helped to save in 2012), matched 100 percent of their available slots. The

Two high school students learn how to give a physical exam during the Future Faces of Family Medicine Program in Santa Rosa, a partnership between CAFP-F and Santa Rosa Family Medicine Residency Program.

success of these new programs highlights the importance of opening more residency training opportunities in California. CAFP/ CAFP Foundation will continue to work to ensure that the family physician pipeline is strong for many years to come. CAFP has not wavered in its support for expanding residency training opportunities in California through advocacy and legislative measures. For example, CAFP sponsored Assembly Bill 1176 aimed at expanding funding for residency training throughout California. And the CAFP Foundation focuses exclusively on supporting California’s family physician workforce by working to increase student awareness of family medicine as a career choice through our Family Medicine Summit (http://www.familydocs.org/ students-residents/fm-summit), support

for Family Medicine Interest Groups at California’s medical schools (http:// www.cafpfoundation.org/programs/ fmig), mentoring programs such as Future Faces of Family Medicine http://www. cafpfoundation.org/programs/fffm, Family Medicine Scholars and more. These programs are possible because of your generous support. Individual donations accounted for 20 percent of the Foundation’s revenue in 2012. Make a difference in the lives of students, residents, physicians, patients and communities in California by making a tax-deductible contribution here: http://cafpfoundation. org/donate The Future Faces of Family Medicine Program thanks you in advance! California Family Physician Summer 2013 15

on leadersHiP

Reflections on NCSC Sophia Henry CAFP sent a full delegation to the 2013 AAFP National Conference of Special Constituencies (NCSC) in Kansas City, MO, April 25-27, 2013. NCSC is the AAFP’s premier forum to address members’ issues specific to women, minorities, new physicians (family docs who have been out of residency one to seven years), international medical graduates and gay, lesbian, bisexual and transgender (GLBT) physicians. The conference is a unique opportunity for members of these underrepresented constituencies to voice their individual and group perspectives, and this year a record high 178 leaders from 41 state chapters participated. Our delegation members not only submitted their own resolutions and/or testified before the reference committees, but some ran for several volunteer and leadership positions as well. International Medical Graduates (IMG) delegate Irina Todorov, MD, served as a member of the reference committee on education, while Scott Nass, MD, MPA, was elected as GLBT co-convener and will serve as a special constituency alternate delegate to the AAFP Congress of Delegates in San Diego. In addition to authoring a number of resolutions, CAFP delegates actively communicated via social media – constantly tweeting, posting and sharing their thoughts on the speakers and our talented aspiring leaders as they ran for office. Resolutions included recommending that AAFP encourage residents to participate in organized medicine, encouraging the production of education materials and handouts for nonEnglish speaking patients and offering behaviorally targeted, site-specific gonorrhea and chlamydia screening or testing for certain high-risk populations. Our delegates came, they saw, they conquered and then attended business sessions to debate and vote on a wide array of issues.

CAFP’s ALF and NCSC leaders

16 California Family Physician Summer 2013

Marie-Elizabeth Ramas, MD, 2013 Minority Co-Convener Who would think that such a small investment in a person could yield such big rewards? This is my impression after returning from my second NCSC meeting. As a new graduate from residency, I came to NCSC last year without expectations, but I left with a new sense of direction and fervor for making an impact on underserved communities by helping create policy change starting at the academy level. In fact, interacting with so many energetic and motivated people encouraged me to run for a position as co-convener of the minority constituency. This conference is a forum provided by the CAFP for underrepresented constituencies within AAFP and also elects delegates who can represent these groups during national policy-making sessions for the AAFP. In addition, this meeting occurs in conjunction with the Annual Leadership Forum (ALF), which targets chapter executive leaders to expand upon their leadership skills. What impresses me the most is that AAFP board members are readily available, lending their knowledge and expertise during the entire meeting. Participants of NCSC become leaders in their chapters, both within AAFP and in their communities. Indeed, no other medical organization invests in identifying, promoting and developing leaders of underrepresented groups. Most family physicians began their careers with the same intention: to make a difference. Our very specialty was

born on this notion. Over the years our role has remained the same, but the public has lost sight of family medicine. Through NCSC, the ember for social activism burns strong! It reminds us as family physicians that we can make a difference no matter where we are, and our patients will thank us for it. The conference provides a chance to get involved, network, find mentorship and form lasting friendships with like-minded people. While people of underrepresented populations have traditionally lacked mentors and support, AAFP has taken the lead to invest in this opportunity for their enrichment.. As a result, it consistently reaps the reward of further representation and active involvement from past participants. I hope to see more registrants next year. Please let your colleagues in other states know, as well as your former residency programs, so that third year family physicians may take advantage of this great experience. The Academy can also reimburse the airfare of one new physician delegate from each chapter and three other delegates from chapters that may not have funds available to send members. See you next year! Interested in getting involved? Contact Sophia Henry at shenry@ familydocs.org.

on leadersHiP

Ed O’Neil, PhD

Meeting the Leadership Challenge Could Change How Health Care and Primary Care are Experienced How do we lead in times of great change? It is a challenging question and one that just about everyone in a leadership role in health care is faced with today … anyone leading the smallest practice to the largest delivery organization. Here are some beginning thoughts on meeting this challenge taken from my 30 years of developing leaders in health care.

Do not defend the status quo This will be a challenge for every leader. Health care in the U.S. has created many good things for consumers and providers alike, but the current approach we’ve taken to health care delivery is not sustainable. To lead the dramatic, and much-needed, change will require a new perspective that takes the outcomes the old way valued and reaches them in dramatically different ways. Defending what was will only get in the way of needed innovation and progress.

Focus on the consumer I use this word rather than patient for a reason. Nowhere does the status quo need to change more than in the relationship between the professional and those who consume the service. We need actively engaged consumers of health and we need providers who see that primary care is not about being a family doc or an internist or a nurse practitioner; it should be about providing services to solve consumer problems in a way that meets or exceeds their expectations as consumers on price, quality and satisfaction. Just as there are lots of different needs within the segments of the consumer market, there will be lots of primary care to meet these varied needs.

Do not over think it This will be hard because most physician leaders will want the proven answer before they begin to innovate. Resist! Create the framework for change, the values to be reached in novel ways, the process to do the work together, but differently and then lead the effort by teams and colleagues as they invent the new primary care approaches as they work side-by-side with one another and the consumer/patient. Living with such a discovery process will test the instinct of every physician who likes to provide leadership from the front. It is time to understand just how radical the change will be, help everyone to come to understand that reality and create a process where real innovation can come forward. This is a complex problem, and the answer cannot unfold until we start the process.

Invest in relationships Because of the uncertainty of the work to be done or even the goal to be reached, an over-investment in managing tasks can be a damaging leadership move. Better to work on improving the relationship of the provider team, developing new ways for the entire staff to be involved, and exploring how consumers can help us understand what they want and need and how they want to receive it. Again, this is not a natural first step when there is “so much to do,” but it is the only one that will secure a process leading to significant change.

Invest in networks For most of the past 50 years we have locked up health care into silos that now defend the status quo. To lead now means a willingness to reach out to others in health care who are working on the same problems and be willing to share with others as they take on the new challenge. It also means reaching beyond where we might have looked in the past. The first outreach should be to the patient/consumer, and then to other service industries, technology firms and public and social enterprises that work.

Innovate, harvest and apply As this is a creation process, it will require that leaders pay attention to the process of fostering innovation, taking what has been learned and applying it to the next problem. Fostering such an enterprise and keeping it running is an enormous leadership challenge and will be easier as more people on your team feel it is their responsibility as well.

Do not make restructuring a fetish Far too often change in health care means pouring old wine into new bottles without actually changing the way we organize and deliver value to the consumer. Spending a lot of time trying to game the system by altering organizational structures without truly innovating will only delay the inevitable and leave the leader less well positioned for the change that must come. These leadership suggestions may seem odd. I have not asked anyone to embrace the PCMH, improve quality or lower costs. I have put before you a much more challenging and perhaps frightening leadership framework; one that could actually change how health care and primary care are experienced. Ed O’Neil, PhD is the former Executive Director of the UCSF Center for the Health Professions. California Family Physician Summer 2013 17

on tHe cover

Introducing Jack Chou, MD … Leading from the Heart CFP magazine recently sat down with Jack Chou, MD, candidate for the AAFP Board of Directors. We had a chance to ask him about his aspirations and inspirations.

Jack and fellow KP teammate discussing a patient care recommendation. Why is now the best time ever to be a family physician? We are in a Renaissance for family medicine. Over the past 10 years, a shift in recognizing the value of primary care has taken place, thanks in large part to the efforts of AAFP leadership. AAFP highlighted the important role primary care plays in providing both high quality care and a more affordable delivery model. Family physicians are especially wellsuited for this role. Did AAFP make the right decision in supporting the Affordable Care Act (ACA)? Why? ACA was designed as insurance reform, but it offered us an opportunity to restructure the health delivery system to bring down health spending and improve quality and outcomes through its various pilot models. It is far from a perfect piece of legislation, but it afforded us an opening to get out of our current fragmented delivery models. Organized medicine recognized this; I think AAFP made the right choice in leading the discussion.

Jack wearing the “colors” at AAFP’s Washington DC rally. 18 California Family Physician Summer 2013

Jack and fellow delegate Carla Kakutani, MD at the AAFP Congress. You’ve ‘come up’ through the ranks at CAFP, starting as a resident member of the board. How has your perspective on organized medicine evolved from your experiences moving through the chairs? I have “grown up” within the Academy. I remember how our board struggled with its decision to pursue a federal antitrust lawsuit to obtain C-section privileges for a member; I’ve learned to make some tough choices as a board member. The most valuable lesson that I’ve learned is that we have to trust one another. We are all in these changing times together. We may disagree; but we’re all coming from the same place: our commitment to serve our patients.

Jack and California Insurance Commissioner Dave Jones, CAFP’s 2011 Champion of Family Medicine

the secret for her to agree to my involvement is my promise to reserve some intensive time for our family. This means that I come home for dinner if I’m not engaged with my other responsibilities and that periodically, we take time away as a family.

Jack at home with his family … ah, balance How has your service in the National Conference of Special Constituencies (NCSC) framed your view of AAFP? What role has NCSC served for AAFP? I’ve always said that the NCSC is the soul of our organization. I return annually to NCSC to be recharged and I always leave with new energy and optimism for our specialty. NCSC allowed us to foster future academy leadership, and I see tremendous value to continuing NCSC as an essential part of our academy. This is a leadership pipeline issue and I am an example of that! What are the three most important challenges confronting AAFP? Budget, budget, budget. While our revenue from membership dues likely will increase, we may continue to see a decrease in our overall revenue. Our challenge is to maintain laser focus on our mission and our core competencies of primary care advocacy and professional development. We must be cognizant of our diverse membership and the challenge to maintain our relevancy. What has been the best part of being a delegate to the AAFP? It’s been getting to know family physicians around the nation. We bring and share our diverse experiences in our daily lives and enjoy one another’s company while working through tough policy choices. How do you balance your family of three kids, a wife, a very full‐time practice, and your volunteer work with CAFP, AAFP and your county and state medical societies? Keeping my wife happy is key to my success. She shared with me that

Jack, with Drs. Carla Kakutani and Dave Bazzo, judging a “Battle of the Residents.”

Who would you say has been your most important mentor within organized family medicine and why? That would have to be the late Dr. Ron Bangasser. He was one of the greats whose life was cut short. In a conversation he and I had after a CMA meeting, he shared his leadership philosophy: he never aspired to become the CMA president. He felt that leadership should be earned; a position of leadership should be bestowed by those who follow, in his view, which I share. I’ve been honored by my California colleagues as they’ve bestowed a number of leadership positions on me, and I am happy to serve in whatever capacity is appropriate. How should AAFP help states respond to efforts to expand non‐ physicians’ scope of practice? We should speak with a single voice and sustain a coherent and timely response. This will require establishing a more responsive communication channel and a more orchestrated approach to any major announcements. What’s the answer to how AAFP and state academies can retain physicians who are employed in their memberships? Employed physicians certainly have different needs. While there may be fewer administrative concerns, more practice autonomy issues and challenges of being in a group practice arise, as well as the rights of employees. Employed physicians share common needs with others as well, such as continuing medical education and maintenance of certification. Where will family medicine be in 10 years? Family medicine will be the most sought after specialty in our nation as we will have revolutionized our health care delivery systems. We will have established primary care as the foundation for patient care with emphasis on quality. We will see increased physician satisfaction under the physician-led patient-centered medical home model of care provision.

Jack leading the IT integration team. California Family Physician Summer 2013 19

http://www.jackchou-aafp2013.org/.

on tHe cover

Jack Chou, MD … At A Glance LeADeRSHIP exPeRIeNCe AAFP Congress of Delegates Minority Delegate, 2003; AAFP Commissions

California AFP (CAFP)

Delegate, 2009-Present; Alt Delegate, 2004-2008; Minority Alt Delegate,2002 Commission on Quality and Practice, member, 2011-Present; Commission on Membership and Member Services, Chair, 2008; member, 2003-2007 President, 2010; Board member, 1998-Present

CAFP Foundation FP-PAC (CAFP)

Board member, 2008-2011 Board member, 2003-2011

California Medical Association

Board member, 2010-present; Council on Ethical Affairs, 2011-present; Alt Delegate, 2002-2010

Los Angeles County Medical Association Ex-Officio, 2012-present; Board member, 2010-2012 Kaiser Permanente Physician-in-charge, 2006-present; Regional Scanning Oversight Committee, co-chair, 2007-present; Regional Health Information Management Committee, chair, 2006-present; IT Steering Committee, Baldwin Park Medical Center, chair, 2009-present; Advisory Group on Clinical Systems, member, 2005-present KP Asian Pacific American Network President, 2006-2008; Board member, 2003-present EDUCATION • UNIVERSITY of Miami, Coral Gables, FL, BS in Biology, 1992 • UNIVERSITY of Southern California, Los Angeles, CA, MD, 1996 • Kaiser Woodland Hills Family Medicine Residency, Woodland Hills, CA, 1999 American Board of Family Medicine, Board Certified TeACHINg exPeRIeNCe • Assistant Clinical Professor, Physicians’ Assistant Program, Western University, Pomona, CA, 2002-Present. • Clinical Preceptor, Family Medicine Rotation, USC Keck Medical School, various months from 2000-Present • Clinical Preceptor, Nurse Practitioner Programs, UCLA, CSUDH, University of Phoenix, various months from 2000-11 20 California Family Physician Summer 2013

TRANSFoRMATIve SKILLS Recent Project Highlights: • Quality Improvement: designed and implemented a Puffball innovative award-winning project that changed the back office nursing workflow to allow frequent blood pressure titration and improved blood pressure control rate of the targeted population by more than 10 percent, with a sustained control rate of more than 84 percent for more than two years. • Financial Stewardship: engaged key stakeholders, including all specialty chiefs of service and medical record office directors of 13 hospitals in Southern California and implemented strategy including presentations to more than 4,500 clinicians, resulting in a reduction in scanning volume and savings of more than $11 million dollars with corresponding decrease in fulltime- equivalent staff in the scanning departments. • Practice Enhancement: actively demonstrated and taught more than 200 physicians to facilitate electronic medical record adoption, including analyzing individual practice patterns and customizing workflow changes. • Population Health: designed an outreach effort for screening chronic disease care gaps in targeted population and bringing these at risk patients into a disease management health fair for testing and treatment. • Infrastructure Improvement: led an inpatient mobility pilot using iPads to improve work efficiency for inpatient hospitalists. • International Engagement: led and presented best practices in hospital operations to various hospitals AWARDS • Physician of the Year, Kaiser Baldwin Park Medical Center, 2011 • People’s Choice, Puffball Award (for Innovation), Kaiser Baldwin Park, 2011 • Service Extraordinaire Award, Kaiser Baldwin Park, May 2011 • Philanthropist of the Year, CAFP Foundation, 2006 • Family Physician of the Year, Kaiser Baldwin Park Family Medicine Dept, 2004

The Core Content Review of Family Medicine Why Choose Core Content Review? • CD and Online Versions available for under $200! • Cost Effective CME • For Family Physicians by Family Physicians • Print Subscription also available • Discount for AAFP members • Money back guarantee if you don’t pass the Board exam • Provides non-dues revenue for your State Chapter

North America’s most widely-recognized program for: • Family Medicine CME • ABFM Board Preparation • Self-Evaluation • Visit www.CoreContent.com • Call 888-343-CORE (2673) • Email mail@CoreContent.com

California Family Physician Summer 2013 21

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22 California CaliforniaFamily FamilyPhysician Physician Summer 2013

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on leadersHiP

CAFP Leaders Offer Guidance and Inspiration Advice to Young Family Physicians Seeking Leadership Roles For future aspiring physician leaders, know the Why. Once you know why you want to lead, apply the same discipline it took to become a physician to the rigorous work needed to be an effective leader. Articulate the Why in two sentences or two minutes or two hours. Look into the facets of your personality and acknowledge your blind spots. Work on increasing your emotional intelligence so that you may better manage the diversity of relationships in your life. Apply your intellect and learn the myriad tools of leadership: strategy, finance, human resources, operations, creativity, policy, etc. And realize that like clinical medicine, it’s never done. There is a natural ebb and flow to organizational growth and change with factors within and beyond our control. As I learned long ago from Dr. Rachel Remen … show up, stay present and don’t be attached to the results, effective outcomes are never really about you anyway. The point of leadership is to marshal group effort for collective success. You are just the catalyst. So, stay hungry, focused, relationship-centered, and humble. Taejoon Ahn, MD, MPH, is Vice President for John Muir Medical Group. Dr. Ahn is a past chair of CAFP’s Legislative Affairs Committee and currently serves on the CAFP Board of Directors.

Changing Tides For 28 years I shared a family practice in the small town of Arcata, California, with my husband, Dr. Alan Glaseroff. Occasionally we would host a resident or medical student, sharing the joy of continuous caring relationships with our patients and their families. We had thought wistfully about how nice it would be to get back into academia and share our insights in patient care and health policy. For the last 18 years, I was the county health officer, enjoying the leadership challenge on the county and state level, including a long tenure in the leadership of the California Conference of Local Health Officers. Because of Alan’s work in the state and nationally on Pay-for-Performance and medical

home standards development, he was approached by Dr. Arnie Milstein of the Stanford Center for Excellence in Clinical Research to establish and run a clinic for Stanford’s self-insured health plan focusing on high utilizers, known as “hot spotting.” I was reluctant to leave my comfortable country life, but a 45-minute interview with Arnie convinced me that Alan and I should head to Stanford together. Out of the blue came the chance. The offer was to establish from the ground up an innovative clinic, putting in place what we had learned and dreamed of for years. Stanford provided a stage from which we could spread the message about patient-centered care, chronic disease management, team care and population health. Although I did not doubt I could do the job, the transition was especially challenging for me, since my leadership credentials were in governmental public health and did not easily transfer to a clinical job in an academic medical center. The California Health Care Foundation Health Care Leadership Program is helping me connect with my new colleagues across the state. On the job, I have had to earn my stripes over again as CoDirector of Stanford Coordinated Care. It has been the most fun work experience for me, both clinically, as a team member and as a leader. We are looking forward to continued development of the clinic and a Team Training Center, where clinical teams come for workshops to help them develop services for patients with multiple ongoing health conditions. Ann Lindsay MD, is a Clinical Professor, Stanford University School of Medicine, and Co-Director of Stanford’s Coordinated Care Clinic.

Leaders Can be Super-Heroes My family medicine leadership story began as many super-hero origin stories do: I was called to action. I was inspired to act by a pair of residents who pushed back against the negativity directed at our specialty by instigating a family medicine t-shirt revolution with positive messages such as “Use your whole brain. Become a family doc.” I felt that a proverbial radioactive spider had bitten me. Sadly, I did not develop the ability to climb walls or sling webs (though I do now have an amazing spidey-sense). The superpower I developed instead is using social media to tell our family medicine narrative and instigate a Family Medicine Revolution. As your New Physician Director, I opened a Twitter account

California Family Physician Summer 2013 23

on leadersHiP in 2009 at the gentle but firm request of your CAFP staff. That account lay fallow for a year and a half because I was juggling work responsibilities with demands at home, including the birth of our second child. Then, with the so-called Arab Spring in 2011, I was compelled to grow the use of my Twitter account after witnessing the immense power of social media to drive rapid transformational societal change. Applying Newton’s 2nd Law to this historic event, generating FORCE equals MASS times, not acceleration, but rather AMPLIFICATION. This force can change the vector of entire systems! Extrapolating this example to health care, we family docs have a historic WINDOW OF OPPORTUNITY to generate the force necessary to move the vector away from fragmentation and volume toward INTEGRATION and VALUE. Using the #FMRevolution hashtag, we have created a growing virtual community of family docs, residents, medical students and other like-minded stakeholders from across the nation and around the world to wrest back control of our narrative, rather than allowing others to tell our story for us. Our leadership story is just beginning. We have the vision, the relationship skills and the know-how to change our patient’s lives. I believe that we have that same “triple threat” to lead change in the health care system if we allow ourselves to be the super-heroes that we wrote about in our personal statements. Jay Lee, MD, MPH, CAFP’s Speaker and former New Physician Director, is Associate Director of the Long Beach Memorial Family Medicine Residency Program.

Leadership is a Journey When I graduated from medical school, I wanted to be a family doctor, care for the poor and save the world. I met most of my goals. I never expected to be the California State Health Officer and Director of one of the largest public health departments in the country. Leadership moments contribute to the leadership journey. During the 2009 H1N1 pandemic, I was the Solano County health officer. A child died from H1N1 and I advised that the school be closed. In a public meeting covered by Bay Area TV crews with hundreds of families attending, I met with the school board. I stood in front of the group answering questions from crying and scared parents. People asked why I did not close the school sooner. I went through my decision-making process. I empathized and shared my fears for my own children. At the end of the meeting people shook my hand and gave me hugs. Leadership often goes unnoticed. Great leaders and leadership opportunities are all around us. I embrace leadership opportunities whenever they arise. My wife jokes that my CV is enough to fill several careers. I am driven by the need to make a difference, be challenged and personally grow. 24 California Family Physician Summer 2013

Leaders are not born; they grow through choices and life circumstances. Leadership development is an endless adventure in personal growth. I chose to serve in leadership positions and balanced this with serious leadership training. So far, I have completed three leadership fellowships including the California Health Care Foundation’s program run through UCSF. The CAFP gave me several leadership growth opportunities when I served on the Board of Directors for four years and the Legislative Affairs Committee for 10 years, and I graduated from its Physician Leadership Program as well. Recently, during a surfing lesson, the instructor told me to start paddling to catch a wave. The wall of water grew higher and higher and I started paddling faster and faster. I caught the wave, at the wrong spot, and ended up flying head over heels over the surfboard. After that wave, he gave advice which serves as a great life lesson for leaders of all kinds. He said, paddle slowly at first, and then pick up speed at the right moment. Next time the wave is heading for you, he said, it might look scary, but just keep paddling. Ron Chapman, MD, MPH, is the Director of the California Department of Public Health.

“Just Say Yes!” When I left my family medicine residency at UCSF in 1982 with my wife and practice partner Ann Lindsay MD, I envisioned a life of small town practice. Both Ann and I had been involved in the formation of the San Francisco Interns and Residents Association and had become somewhat jaded by that experience. We left academia running! In Arcata, CA (Humboldt County) we lived a great country life, practicing medicine the way we wanted to, raising our children, and planning to generally avoid any leadership role in the medical community. However, the best-laid plans often come apart when faced with problems that demand solutions. In my case, I developed Type 1 Diabetes, which exposed me to what all patients with chronic conditions face in seeking medical care that meets their needs. At first, I attempted to see all of the patients with insulin-dependent diabetes (Humboldt is too small a county to support an endocrinologist). I quickly saw my practice transforming from a general family practice into a diabetes practice, a change I neither sought nor wanted. Suddenly I found myself giving Grand Rounds presentations to my colleagues on how to teach self-management to patients with diabetes. These didactic lectures had little if any effect. Around that time I was offered a very part-time role to serve as medical director of the local Foundation for Medical Care; frankly, we needed the extra money that came with the position. That job eventually became a half-time job as Chief Medical Officer of the newlyformed Humboldt-Del Norte IPA. Likewise, Ann was asked to serve as interim Local Health Officer, a job that turned into a permanent

PHYSICIAN – FAMILY MEDICINE Vista Community Clinic located in North San Diego County half-time position in which she served for 18 years, eventually as President of the California Council of Local Health Officers (CCLHO). We also continued our practice. Upon the urging of my CEO, Martin Love, I applied for and was accepted as a fellow in the brandnew California Health Care Foundation (CHCF) Leadership Program in 2001. We soon received a grant from CHCF to start the Humboldt Diabetes Program, which resulted in our county being the first in the country to achieve official recognition from the National Committee for Quality Assurance for Diabetes. I started this work by revealing my own practice results to my colleagues (embarrassing!), and challenging them to do the same. This led to the creation of a web-based diabetes registry that currently holds around 90 percent of all patients with diabetes in Humboldt County. By the end of eight years, deaths due to diabetes in Humboldt had fallen 29 percent, while the death rate statewide remained unchanged. While the cause of this drop remains unclear, we were excited to see it happen. I began to receive offers to teach in diabetes collaboratives and eventually lead them. I wasn’t at all sure that I wanted to travel and take on extra responsibility, but I took the leap and spent the next five years “just saying yes” to interesting offers. This work has given me tremendous professional satisfaction; the offers grew in magnitude to the point where I was asked to serve on many prestigious committees that guided health care policy in Californnia and nationally. Now Ann and I are back in academia at Stanford, opening an innovation program for patients with complex chronic illness called Stanford Coordinated Care. We love our work, and it all came about because we started “saying yes.”

Seeking: Full-time, part-time and per diem Family Medicine Physicians. Requirements: California license, DEA license, CPR certification and board certified in family medicine. Bilingual English/Spanish preferred. Contact Us: Visit our website at www.vistacommunityclinic.org Forward resume to hr@vistacommunityclinic.org or fax resume to 760-414-3702

REAL ISSUES. REAL AnSwERS. R EA L voic Es.

Alan Glaseroff MD, is a Clinical Professor, Stanford University School of Medicine, and Director of Stanford’s Coordinated Care Clinic.

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PHYSICIAN – OBSTETRICS AND GYNECOLOGY

Vista Community Clinic located in North San Diego County Seeking: Part-Time and per diem OB/GYN Physicians. Requirements: California license, DEA license, CPR certification and board certified in obstetrics and gynecological medicine. Bilingual English/Spanish preferred. Bilingual English/Spanish

Contact Us: Visit our website at www.vistacommunityclinic.org Forward resume to hr@vistacommunityclinic.org or fax resume to 760-414-3702 California Family Physician Summer 2013 25

on leadersHiP

CAFP Proudly Honors Six Family Medicine Leaders

From Left ... Tom Bent, MD; Michelle Quiogue, MD; Alex Sherriffs, MD; Raul Ayala, MD; and Joan Rubinstein, MD

Each year the Academy and Foundation honor a group of family physicians who represent the very best of the specialty â&#x20AC;Ś this year six family physicians who have led the charge in community activism, education, innovation, and advocacy have been selected. In addition, we are awarding the first Preceptor of the Year Award. Congratulations and our most sincere thanks to these incredible leaders!

Michelle Quiogue, MD 2013 CAFP Family Physician of the Year The California Academy of Family Physicians presents this prestigious award to an individual who exhibits the finest qualities of family physicians and who goes above and beyond in service to patients and community. Dr. Quiogue exemplifies all that is right about family medicine; she is an advocate for her patients, her Academy, her specialty and her community. In her mere 10 years of practice, she has assumed leadership roles in her medical facility, county medical society, the CAFP and the AAFP. Her active engagement in her community ranges from her work in her childrenâ&#x20AC;&#x2122;s school to serving as a key contact for her state and national legislators, from spearheading 26 California Family Physician Summer 2013

the launch of a mobile health unit to working to save a residency program. In 2012, the family medicine residency program at Kern Medical Center decided not to select a new PGY-1 class of doctors-intraining, citing funding deficits as the reason. Dr. Quiogue singlehandedly rallied interest and spent countless hours campaigning to save the program. Many in her community believe Dr. Quiogue not only saved the program, but also saved many people in the community who would have accessed the emergency room rather than seeing their primary care physicians. When Kaiser Permanente invested in a Mobile Health Vehicle to service outlying members in Kern County, Dr. Quiogue was one of the first physicians to volunteer. She has been adamant about making sure that outlying members receive the same continuity of care they would receive in Kaiser Permanente facilities. Dr. Quiogue is also actively engaged in the politics of family medicine, serving as a California Academy of Family Physicians delegate to the CAFP Congress of Delegates and as a key contact to legislators in her local district as well as to federal officials. She is also a member of the AAFP Commission on Health of the Public and

Science and serves on that commission’s Subcommittee on Health Equity, as an Alternate Delegate to the U.S. Breastfeeding Committee and as Vice Chair, AIM-HI. In addition to her advocacy roles, she serves on the Board of Directors of her county medical society and as an alternate delegate to the California Medical Association’s House of Delegates. She has also served on CAFP’s delegation to the CMA Specialty Delegation. Finally, Dr. Quiogue is a role model for physicians trying to “have it all.” She and her husband, Jason Sperber, decided when their first daughter, Lucy, was born that Jason would be the at-home parent. Jason is now home with Lucy and daughter number two, Emi. Dr. Quiogue and Mr. Sperber have been models for others making this decision and in the ongoing fight for life-work balance. Dr. Michelle Quiogue is a true leader and role model for her peers. She is an active spokesperson for the specialty of family medicine as well as for family physicians’ roles in family, education and public health. Through her involvement with CAFP/AAFP, she has reinvigorated a community of physicians and lit the torch for the future of family medicine.

There’s a bright future waiting for you on California’s beautiful Central Coast. California’s breathtaking natural attractions are not the only stars on the Central Coast. Equally impressive are the top-trained medical professionals at Natividad Medical Center (Natividad), a 172-bed acute care medical center owned and operated by Monterey County. Affiliated with the University of California at San Francisco School of Medicine since 1974, we are located near Big Sur, Carmel and Monterey. We offer an excellent family practice residency program and enjoy a Joint Commission ranking in the top percentile of hospitals nationwide.

FAMILY MEDICINE PHYSICIAN Well-known West Coast Family Medicine Residency Program seeks a strong faculty member with interest in academics. Natividad Medical Center Family Medicine Residency Program has been in existence since 1975, and provides care for a largely Medicaid/underserved population in the Salinas Valley. Our program has an emphasis on Obstetrics and Inpatient Medicine, and we are expanding our resident cohort from 24 to 30 spots. We look to expand the number of faculty members over the next two years, but are looking to fill one full-time position at this time. This position also involves supervising Residents and Medical Students in the Family Medicine Residency clinic, on the Inpatient Units and while on call (call is approximately 3 times/month). The ideal candidate will be a Board-Certified Family Physician with an interest in academics as well as general family medicine. Training and experience in Sports Medicine or Geriatrics is a plus, but not required. Faculty development, up to and including the UCSF faculty development year-long course and NIPDD training, may be available for the selected candidate. Natividad offers a competitive salary and benefits package, and the opportunity to live, work and play in one of the most beautiful areas in the world. Please visit our website at www.natividad.com. For consideration email your CV to: ramirezcl@natividad.com. EOE/M/F/H/V

Unique views on the Central Coast.

Thomas C. Bent, MD 2013 CAFP Foundation Barbara Harris Award for educational excellence Tom Bent, MD is a leader in family medicine, an excellent clinician and a superb teacher. He is a CAFP Past President, has served on the CAFP and AAFP Committees on Professional Development and chaired the AAFP Committee in 2006. Dr. Bent is a founding mentor in the CAFP Continuing Medical Education (CME) Leaders Institute and has mentored many medical students and residents throughout his career. As an educator, he brings his inherent qualities of insight, humor and compassion to bear in a unique and engaging blend. He is able to connect with learners on common ground and with a sense of the “common man” (doctor); he places himself on par with his audience and thus gains their attention, interest and, most importantly, their trust. This stance enhances the audience’s ability to attend, focus on and grasp important

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California Family Physician Summer 2013 27

educational content. When it comes to medical education, Dr. Bent simply “gets it,” and has inspired many young physicians to become active and engaged family medicine physicians. In addition to his teaching, Dr. Bent has delivered care to underserved patients in California for more than three decades. He brings a unique, caring perspective to the art of family medicine. A staunch and untiring advocate for enhanced access to care for all patients, he is a talented and compassionate clinician. The insight gained from Dr. Bent’s experience is evident in every aspect of his work, from his sophisticated and accepting worldview to his wry and ready sense of humor. In spite of the many roles he has had, being the personal physician to his patients is likely his favorite accomplishment. Former resident and current member of the CAFP Board of Directors, William Woo, recalls Dr. Bent’s passion for education: “He took the time not only to discuss each patient’s medical issues, but he also found learning points in even the most routine cases. Dr. Bent not only teaches clinical topics with aplomb, but some of the most important lessons former students and residents recall were on building the physicianpatient relationship.” Dr. Bent has forged strong relationships with his patients, many of whom have been seeing him at the community clinic for years. CAFP is proud to recognize Tom Bent’s more than two decades of excellence as a family physician educator. His contributions are far-reaching. From providing clinical care to thousands of patients in many different settings to lending his leadership expertise to numerous organizations, including our specialty, Tom Bent has worked selflessly. He has educated countless medical students, residents, and staff physicians from the local to the international level, matched only by his research contributions. And,of critical importance, he has improved the lives of those less fortunate in his community.

Raul Ayala, MD 2013 CAFP Foundation FM Resident of the Year The California Family Medicine Resident of the Year award is given to a resident who represents the finest characteristics of family medicine. This year CAFP is honored to give the 2013 award to Raul Ayala, MD, Chief Resident, University of San Francisco-Fresno’s Family Medicine program. Dr. Ayala may have had limited free time as a resident, but much of it was spent giving back to others. Dr. Ayala has represented CAFP as co-chair of our Resident and Student Council, at AAFP’s National Conference of Special Constituencies in 2011 and as coresident member of the CAFP Board of Directors. He regularly gives back to his own community by working to organize the residency programs in the area and connecting them with their county academy chapters – the Central Valley Alliance project. He has worked tirelessly on initiating community-wide events 28 California Family Physician Summer 2013

and hopes to bring a mobile clinic program to counties in the Central Valley this year. Dr. Ayala holds a Bachelor of Science degree in biology/chemistry from the University of Texas, San Antonio and attended the Universidad de Montemorelos, Mexico for medical school. He completed his education through the Fifth Pathway Program at New York Medical College. Dr. Ayala represents everything great about the future of family medicine – he is dedicated to maximizing his impact on patient care through excellent clinical skills, and also through his participation in organized medicine and the political process. Dr. Ayala says he hopes to one day serve a community in need, but we hope he realizes that his energy and enthusiasm is already a beacon of light in his community.

Alex “Sandy” Sherriffs, MD and Joan Rubinstein, MD 2013 CAFP Foundation Preceptors of the Year This is the inaugural year for this award honoring family physicians who precept and mentor our future generations. 2013, marks the 30th anniversary of the CAFP Foundation Summer Preceptorship Program. Each summer, 40-50 first-year medical students have the opportunity to spend four weeks with a practicing family physician. It is our pleasure to award the first annual Preceptor of the Year award to two physicians who have been mentoring students since the beginning of our program, Drs. Joan Rubinstein and Alex Sherriffs. For more than 17 years, Drs. Rubinstein and Sherriffs have mentored at least one medical student each summer in their Fowler practice, providing students an opportunity to engage in work in a thriving rural health center. Students experience true full-scope family medicine in Fowler, including flexible sigmoidoscopies, colposcopies, endometrial biopsies, vasectomies and multiple minor surgical procedures. In addition to their work in Fowler, Drs. Rubinstein and Sherriffs are clinical professors in family and community medicine at UCSF Fresno. They are actively involved in their local community, serving on the boards of multiple organizations and cherishing their Fowler community, where they raised their two daughters. They are known throughout their community as the town doctors and have been instrumental in supporting community projects, such as raising funds for a community running track. Drs. Rubinstein and Sherriffs, native Californians, met during medical school at the University of California, Davis. They were married during their residencies at Valley Medical Center in Fresno. Drs. Rubinstein and Sherriffs have made their mark on many of California’s best and brightest family physicians, with every former preceptee reminiscing about their incredible experience in Fowler. Almost every residency program in family medicine

has read at least one essay about time spent in Fowler with the Rubinstein-Sherriff family and the impact of that summer on their lives as future family physicians.

Catherine Sonquist Forest, MD, MPH 2013 CAFP “Hero of Family Medicine” CAFP developed this award to honor a family physician who has gone above and beyond the call of family medicine and who has represented our specialty, our profession and our patients so ably as to be called a true “HERO.” The 2013 award was presented at the Congress of Delegates in March to Catherine Sonquist Forest, MD. Though Dr. Forest is winning this award for 2012-2013, she has been a hero to her patients and to her family physician

colleagues for her entire career. Dr. Forest earned her medical degree at the University of California San Francisco, and completed her family medicine residency at the community hospital in Santa Rosa, where she was chief resident. She also earned a Master’s degree in public health at the University of California Berkeley and completed a public health fellowship at the National Institutes of Health. Since then, she has been the epitome of a true family physician champion. She has served for several years on CAFP’s Legislative Affairs Committee, tackling special assignments on health care reform, women’s health, public health, the medical home and reproductive health. She is one of the inaugural CME Leaders Institute fellows, plays a prominent role on the CAFP ad hoc Committee on Scope of Practice and has represented CAFP at the CMA House of Delegates. Her relentless political advocacy led her to be named April 2012’s FP-PAC Donor of the Month, and within the last few years, she has hosted several events in her home on behalf of FP-PAC for the chair of the Assembly Health Committee, Assembly member Bill Monning. She has also been an outstanding key contact, meeting repeatedly with legislators in her district and in the Capitol, advocating for her patients and the issues most important to family physicians.

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Susan Hogeland, CAE

executive vice President’s Forum

Family Physicians Can Help Patients Understand ACA During the health care reform debate, and shortly after its passage, I was struck by the amount of misinformation and plain lack of knowledge polls revealed among members of the public about this important legislation I’ve written before

about the bogus “death panels” decried by opponents, but that was just the worst among many false claims. The Accountable Care Act (ACA) was passed three years ago; the Supreme Court of the United States has upheld the vast majority of its provisions. Family medicine was a leader in advocating for health coverage for all – CAFP and AAFP worked to ensure both near universal coverage and the primacy of primary care in the legislation. We also worked to disabuse members, legislators and patients of many of the false claims about the bill. Yet three years after passage, it appears a majority of Americans are no better informed now than before about the provisions of the ACA and their impact on access to care. Since this issue of California Family Physician is about leadership, I challenge family physicians to better inform themselves about the ACA and help inform their patients about its effect on access to care. Polling data released by the Kaiser Family Foundation (KFF) on April 30 found a lot of confusion about the ACA. For example: 1. Four in ten Americans (42 percent) don’t even realize ACA is the law of the land! That includes 12 percent who think Congress has repealed it (in fairness, the House of Representatives has done so, 37 times, but the Senate has not concurred), seven percent who think the Supreme Court OVERTURNED it, and 23 percent who don’t even know enough to comment on its status. 2. Half of the public say they don’t know enough about the legislation to say how it would affect their own families. 3. Among that group, the largest share of those who don’t know much are those who will most benefit from the law – the uninsured and low-income households. Where are people getting their information about the ACA? It sure isn’t from health care professionals, insurers, employers or notfor-profit organizations – only 10 percent of members of the public cite such sources, says KFF. Forty percent cite friends and family; “newspapers, radio news or other online news sources” are cited by 36 percent and cable news by 30 percent. Another nine percent cite federal agencies and eight percent cite state agencies. I am among those who think the Obama Administration didn’t do a very good job of promoting the ACA before it passed, and it and we apparently aren’t doing a very good job of informing the public about its current and future benefits. On March 24, a New York Times editorial said “It (health care reform) has done a lot more in its first three years than most people realize,” and outlined how 30

California Family Physician Summer 2013

coverage for children up to age 26 was expanded – up to 6.6 million of them, including three million previously uninsureds, can now stay on or join their parents’ health plans as a result of ACA. Additionally, private insurers now must provide free preventive care, without copays or deductibles, a benefit to some 71 million Americans, and an additional 34 million under Medicare in 2012 alone. Children with pre-existing conditions now must be covered under private plans – 17 million of them. 107,000 adults have enrolled in a federally-run insurance plan for people with pre-existing conditions, and insurers no longer can cancel policies of people who are sick – positively affecting about 10,000 per year. $11 billion has been appropriated over five years to build and operate community health centers, which will help expand access to care. The medical loss ratio for private insurers was increased to 85 percent from 80 percent – so more money is being spent on care, and less on administration and profit. The list goes on. Not the least of these benefits is exciting and innovative experiments in care provision such as Accountable Care Organizations and the Patient Centered Medical Home. ACA isn’t a perfect bill; far from it. But here in California, we got a jump start on providing coverage through our health benefit exchange, Covered California, which Governor Schwarzenegger promoted immediately after the ACA was signed into law. Covered California is on schedule to begin accepting applications for coverage in October of this year and announced the health plans it will sell on May 23. Will there be glitches? Of course! Both humans and computers are involved. But we should give ourselves and our state a little pat on the back for moving forward to ensure access to care for millions more Californians. Family physicians will play a major role in provision of that care, so kudos, everyone. Perhaps it would behoove family physicians, in talking with patients during visits, to say a little something positive about the ACA and its impact – patients respect and trust your opinions and you could do a lot to better inform them about the ACA. I had the privilege of attending the California Association of Physician Groups’ Annual Meeting in Los Angeles in early June, at which the keynote speaker was President Bill Clinton. President Clinton noted that California was a model for the rest of the nation in the years ahead because of its work on affordable, accountable, quality care. He emphasized that the triumphant species on earth are the cooperators – ants, bees, termites and people – in fact, he used the term “genius cooperators.” He noted the best things are driven by networks of creative cooperators. It seems we have an opportunity now, with health care in California, to be those genius cooperators of whom President Clinton spoke. Let’s not miss the opportunity.

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